Podcast 002: Dr. Marshall Kapp - Deregulation of CON in Florida

With the Florida House recently passing a bill that would eliminate the Certificate of Need (CON) process in Florida and the bill now on deck in the Senate, I think it is important now more than ever for the public to have a good understanding of the possible implications this deregulation could have. Tune in to my podcast as I discuss CON with Dr. Marshall Kapp and hear his opinions on the topic.

Dr. Marshall Kapp is the Director of the Florida State University Center for Innovative Collaboration in Medicine & Law, and a faculty member at the College of Medicine and College of Law. He is a member of the American Medical Directors Association Foundation, Scientific Council, and the editor of the Journal of Legal Medicine, a publication by the American College of Legal Medicine. He is an expert on the Certificate Of Need Program (CON), and has co-authored the Healthcare Foundation of South Florida’s study on the need for CON in Florida.




 Key Takeaways: [:25] This episode's topic is Certificate of Need — Deregulation in the State of Florida. [:56] What is the Certificate of Need Program (CON)? [1:36] Read more about John's perspective on the deregulation of the CON at his blog. [1:48] Today's guest is Dr. Marshall Kapp and he will be sharing his view on the CON. [2:53] What is Marshall's opinion on Certificate of Need from an academic, scholarly perspective? [6:16] What makes the healthcare industry different, that regulation is necessary, and competition is not necessarily a good thing? [13:26] What would a deregulated Florida look like for the healthcare consumer? [18:00] Has Marshall seen the negative impacts of deregulation play out in other parts of the country? [19:30] John strongly believes that everyone in the community deserves access to the best, most affordable healthcare, so he advocates for legislators to put down the CON Deregulation Legislation. You, too, should reach out to your legislators and make your voice heard! Mentioned in This Episode: Inventing Health with John Couris Inventing Health on iTunes John Couris on LinkedIn

Nobody in the middle of a heart attack shouts, “Let's go shopping!”

   

As many of you know, I have been doing a lot of reading and research surrounding this issue of the deregulation of the Certificate of Need (CON) and have been writing extensively about the reasons why the legislature here in Florida should not repeal the program. Recently, the State Senator Rob Bradley introduced legislation (SB 676) to repeal CON in Florida and House members Miller and Renner subsequently offered a companion bill in the House (CS/HB7).

As I argued in a recent post, No Place for Health Care in a Free Market Economy, health care does not operate in a free market space. Therefore, the benefits of deregulation do not apply to health care as they do, say, in the airline industry.

I recently came across this clever 2014 “listicle” by Merrill Goozner from Modern Healthcare which gives a Late Night with David Letterman “Top 10” send up of the reasons why health care is not a free market. I found his list to be fairly spot on and worth sharing. Here is a recap of his list:

10. “Most care is delivered locally and will remain that way.” This is his way of explaining that competition by foreign competitors, which can affect price, does not really exist in health care.

9. “Physician assistants, nurses, lab techs and other specialized personnel labor under overly restrictive licensing laws” and thus, the workforce is not easily replaceable.

8. “Doctors belong to professional guilds” which limit access to the profession and establish licensing protocols regardless of cost.

7.  “Pharmecutical and medical device firms use patent monopolies” which equates to very high prices.

6. “Most non-routine healthcare is delivered by not-for-profit charities.”

5. “Comparison shopping is complex for patients, as well as confusing and nearly impossible, because outcomes are variable, success isn't guaranteed.”

4.  “The law says no one can be denied healthcare when needed.”

3. “Patients, even those in high-deductible insurance plans, pay for only a fraction of the cost of healthcare.”

2. “Insurers can pass along all costs in the form of higher premiums”

1. And the number one (1) reason why health care is not a free market . . . .“nobody in the middle of a heart attack shouts, “Let's go shopping!”

Again, if you are concerned about how the deregulation of CON and specifically, Senate Bill (SB 676) or House Bill (CS/HB7) will affect your access to high quality and affordable health care, I encourage to reach out to your legislators and make your voice heard.

Like what you read? Want to keep in touch? Please connect with me on LinkedIn.

No Place for Health Care in a Free Market Economy

Last week, Florida State Senator Rob Bradley, State Senator Rob Bradley  introduced legislation (SB 676) which seeks to repeal the Certificate of Need program here in Florida. Despite the potential for an increase in cost and decrease in quality, that would come with deregulation, Governor Rick Scott has expressed his support of the legislation.

As I have explained in my previous posts, the Certificate of Need program is a regulatory process that requires certain health care providers to obtain state approval before offering new or expanded services. The CON program in Florida regulates the construction of new hospitals, hospices, skilled nursing facilities, and care facilities for the developmentally disabled, as well as certain hospital services.

As you also know, I oppose the deregulation of CON, in particular as it relates to the creation and expansion of inpatient care. I have outlined in significant detail the negative effects deregulation of CON would have in previous posts but in short, I believe it will have a negative impact on cost, quality and access to health care in our state. However, Senator Bradley, Governor Scott, and those who support the elimination of CON believe that free market forces will improve quality while lowering costs.

And while I staunchly believe in free market economics, the reality is that health care does not operate in a free market space. In a free market economy, prices, quality and quantity of goods and services are determined by the open market and consumers.  In addition, the government imposes very little - if any - restrictions and regulations on the forces of supply and demand that drive the costs of goods and services.

Hospital pricing cannot be determined by a free market system because a hospital cannot set their own pricing for services. Hospitals are reimbursed for services based on rates established by the Centers for Medicare and Medicaid and thus, must work with insurance providers and government agencies to negotiate wholesale pricing. In addition, hospitals cannot provide or deny services based on a patient’s ability to pay, making the system of supply and demand irrelevant. For example, if a patient comes to the ER requiring stiches, federal law requires that they be treated even if they do not have insurance or the money to cover the cost of the treatment they received.

Additionally, hospital and health care pricing is also incredibly complicated and there is a scarcity of price information out there for consumers. This makes shopping for certain types of health care services incredibly difficult and many times, consumers won’t know exactly what they owe for a procedure until they get the bill. There also tends to be significant variety in pricing from provider to provider and cost does not always directly correlate to quality. This is yet another complication when it comes to health care in a free market space.

When new hospitals come into the region due to deregulation, they will look to compete for patients with insurance coverage or the financial means to pay for their own care. And so, while I am a big believer in free market economics and know the positive effects it has on many sectors of our economy, free market economics and deregulation simply don’t work when it comes to health care. Despite the belief of those who support the legislation, it will drive up costs and decrease quality. Take it from someone who has been working to provide quality health care to the consumer for the past 20 years.

And so what, now? As I have said before, I think here in Florida we can buck the trend, put party politics and ideology aside and come together in the spirit of doing the right thing for our State when it comes to access to high quality and affordable health care. I don’t think we need to rush bills into the legislature but instead, we can sit down at the same table and thoughtfully and engage with each other to work towards a positive outcome that puts consumers and our neighbors first.

It is in this spirit that I want to challenge our legislators to put together a statewide “blue ribbon” working group comprised of legislators, health care leaders, physicians, medical professionals and patient advocates. This mission of this group will be simple: to come together, roll up its collective sleeves and work toward providing the highest quality and most affordable health care for this State’s most precious resource—Floridians.

Finally, if you are concerned about how the deregulation of CON and specifically, Senate Bill (SB 676) will affect your access to high quality and affordable health care, I encourage to reach out to your legislatorsand make your voice heard.

Like what you read? Want to keep in touch? Please connect with me on LinkedIn.